Thinking about home care?

So often, we are faced with a medical condition in ourselves or a loved one that requires skilled care—like the care a nurse or doctor provides. For some of us, those conditions are chronic and we need that skilled care often, even around-the-clock.

Home care is offering more and more kinds of medical care in your home. With Skype and certain technologies that take vital signs and relay them in real time, it’s even possible for technologically advanced but home-bound individuals to “see” their doctor. Sometimes medical needs can be met by home care, but sometimes the hands-on skill and security of a nurse who’s available any hour of the day or night just can’t be replaced.

How can you tell when home care is appropriate?

The first question to ask is where will you be most comfortable? Most people would answer “at home,” but today’s nursing homes work hard to help our residents make a new home. The key is to look at how much help is needed. If you can bathe, dress, and feed yourself, and go to the bathroom without help (all known as activities of daily living), then you may be just fine at home with the assistance of someone who can do the shopping, cooking, and cleaning.

But if you need help with three or more of those daily activities, life may be much easier with a nursing home’s round-the-clock assistance, unless you can afford to hire three shifts of trained caregivers a day.

Another question to ask is how you’re going to pay for the care. If you can pay out of pocket, and you only need skilled care every now and then—even changing a catheter or monitoring intravenous fluids—either setting may be fine.

If you have long term health care insurance, check the policy to see what’s covered.

If you’re relying on Medicare to pick up the tab, don’t expect too much. Medicare will only pay the first 20 days of home care and then only if the person has just had a hospital stay of three days or longer. For the next 80 days, you’ll have a co-pay near $100 per day, and no coverage is provided at all after 100 days.

Of course, it’s very similar with nursing homes. Medicare just doesn’t pay for long term care.

If the person you’re paying out of pocket, you may spend all of your money and eventually qualify for Medicaid, but even Medicaid doesn’t provide unlimited home care.

Where Medicaid will pay for nursing home care for as long as it’s needed, SoonerCare only pays for up to 36 home care visits in a year. So if you have many health needs, home care as paid for by SoonerCare won’t cut it.

Another thing to keep in mind is that nursing homes in America are subject to hundreds of regulations that ensure everything is as it should be. Home care, because of its nature—so many unsupervised workers providing care in homes that may be less than sanitary—doesn’t have to conform to as many regulations. In some ways that makes care provision more personal; in other ways it makes it more dangerous.

If you do decide to go with home care, at least at first, you might want to contact the Oklahoma Association for Home Care (OAHC). They have a code of ethics that their members are encouraged to adhere to; you can call them at 405-663-2067 and ask for a list of member facilities near you that have signed on to that code of ethics.

You might want to make sure the home care agency is certified by Medicare, because that means it has met some federal regulations, although just because an agency isn’t Medicare-certified doesn’t mean it provides poor services.

You can ask if the agency is accredited, which is a voluntary process that helps ensure quality.

OAHC recommends you get everything in writing before you sign up—documents that describe services, eligibility requirements, fees and financial arrangements.

Find out how they choose and train their employees and if they have a professional agency staff member available for phone consultation 24 hours a day.

Does the agency make supervisory visits to the patient’s home and regularly evaluate the quality of care being delivered? How does the agency develop care plans, and will you get a copy along with a list of patient rights and responsibilities?

Ultimately, federal regulations or not, you’re responsible for making sure you receive safe and affordable care in a comfortable setting. It’s nice when you can stay in your own home, but if you can’t, nursing homes really do become “home” for our residents. At Bell Avenue, I know, we work hard at that.